A clinical study of cerebral venous thrombosis

Abstract

Background: Cerebral venous thrombosis (CVT) is an uncommon form of stroke, usually affecting young population. Clinical features of CVT are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions. The objectives of the study were to analyse the commonest clinical modes of presentation, possible etiologies, and to evaluate clinical outcome.Methods: This study was prospective, clinical study was conducted on 40 patients during the period of September 2010 to September 2011 in the Department of Emergency, Institute of Internal medicine at Government General Hospital (GGH), Chennai. All the patients included in the study were subjected to neuroimaging techniques like Computed tomography (CT), magnetic resonance imaging (MRI) along with magnetic resonance venography (MRV) according to guidelines and standard protocol.Results: Majority of the patients involved in the study were in the age group of 15-35 years contributing to 75%. Male: female ratio was 1.5: 1. Headache was the most common presenting symptom seen in 36 (87.5%) cases followed by convulsions in 32 (80%) patients. Altered sensorium was observed in 26 (65%), focal deficits in 22 (55%), and 18 (45%) had fever. Two of them had ear discharge and another with diarrhea. Cranial nerve involvement in 35% and pappiledema was noted in 20% of patients. Out of 40, 17 (42.5%) patients were anemic. Eighteen (18) patients who were suspected of meningitis underwent CSF analysis. Abnormality was seen in 10 patients with pleocytosis being the maximum. On CT scan, haemorrhagic infarct was seen in 22 (55%) cases followed by edema in 8 (20%) and 10% showed normal CT picture. On MRI scan, superior sagittal sinus thrombosis was observed in 24 (60%) patients followed by transverse sinus in 20 (50%) patients. Etiology factor were identified in 25 (62.5%) of patients and in 15 (37.5%) cases risk factors could not be identified. The mortality rate in the study was 20%.Conclusions: The clinical symptoms of CVT are not specific, as a result of chances of misdiagnosis tends to be more. CT scan and MRI along with MRV can improve the precision of CVT diagnosis.